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December 22, 2014

Posts in "Medicaid"

December 12, 2014

Medicaid Doctors Set for a 42 Percent Payment Reduction

Congress is preparing to conclude the current term without action on extending relief from upcoming cuts in Medicare and Medicaid physician payments. There still is time for the next Congress to act on what is familiarly known on Capitol Hill as the “doc fix” before payments are reduced on April 1. However, a separate cut in Medicaid physician fees for primary care services is set to begin on January 1, 2015.

The Affordable Care Act included a temporary increase in federal Medicaid funding to increase payments to physicians to match Medicare payment levels. The temporary period expires at the end of the year. A report released on Wednesday by the Urban Institute estimates that the payment expiration will lead to a 42.8 percent reduction in fees for primary care services for eligible providers. However, the fee reduction varies because some states plan to continue higher physician payments by using separate state funds.




By Paul Jenks Posted at 9:31 a.m.

December 10, 2014

Audit Report Exposes Flaws in Medicaid Networks

Many primary care physicians accept Medicaid patients. However, finding them can be difficult. Federal auditors examined lists of physicians supposedly covering Medicaid patients and found that more than half of primary care doctors were no longer at the address listed or do not accept Medicaid patients. The HHS Inspector General also found that 35 percent of Medicaid managed plans offered inaccurate information on providers, but the report did not assess access for fee-for-service Medicaid patients. Additionally, the auditors found that the median wait-time for an appointment is two-weeks, with some as long as a month and 10 percent requiring a two-month or more wait.

CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reported (subscription) Tuesday that the audit findings raise questions about whether plan networks are broad enough to serve the influx of patients entering the Medicaid system. Also, network woes could also apply to non-Medicaid insurance coverage offered by the health care law’s marketplace plans.

The auditors recommended:

CMS work with States to (1) assess the number of providers offering appointments and improve the accuracy of plan information, (2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and (3) ensure that plans are complying with existing State standards and assess whether additional standards are needed. CMS concurred with all three of our recommendations.


By Paul Jenks Posted at 10:50 a.m.

November 19, 2014

The Other Physician Payment Extension Deadline

A seemingly permanent fixture on the congressional agenda is ongoing action to thwart cuts to Medicare payments to physicians and other health care providers. Congress is always focused on the annual effort to halt substantial Medicare payment cuts to doctors. However, there is another looming deadline on enhanced Medicaid payments to primary care physicians.

The Affordable Care Act included a provision that allowed for increased Medicaid payments to primary care physicians at 100 percent parity with Medicare payment rates. The revised payment program began in 2013 but the enhanced payment term was limited to two years and is now set to expire. Unlike the Medicare physician payment deadline, which expires on March 31, 2015, the Medicaid parity payment adjustment expires on Dec. 31, 2014.

A prepared Senate bill (S 2694) offers a parity payment extension for two more years and adds payments to other physician groups. The White House’s initial request for a stopgap-spending bill in September also included a suggestion for an extension of Medicaid payments. Congress now is scrambling to craft the elements of a final year-end omnibus spending bill or another stopgap funding resolution. If the Medicaid payment parity adjustment expires, physician groups likely will to press for retroactive adjustments in next year’s spending bills.



November 5, 2014

Governor Race Results Signal Limited Medicaid Expansion

Most of the focus on Tuesday’s general election was on which party would control the U.S. Senate next year. The Republicans gained a shift in control of the chamber. Meanwhile, separate state governors’ races included a focus on an expansion of the Medicaid program.

The 2010 Affordable Care Act includes incentives to states to expand the Medicaid program. However, twenty-three states have yet to expand Medicaid eligibility under the health care law. CQ HealthBeat’s Rebecca Adams reported (subscription) prior to the election that many Republican governors have balked at an expansion, though a few GOP state chiefs in Utah and Indiana have adopted elements of expanded Medicaid eligibility. Governors of both parties also must negotiate with state legislatures to allow for an enlarged state-managed Medicaid program.

Races on Tuesday that focused on the Medicaid expansion included reelection challenges t0 several GOP governors who have rejected a full Medicaid expansion.  Democratic challengers did not fare well against the established Republican incumbents. Here is a rundown of some selected state governor elections:

  • Florida: Governor Rick Scott defeated Democratic challenger Charlie Crist
  • Maine: Governor Paul R. LePage (who has vetoed Medicaid expansion proposals) defeated Democratic challenger Rep. Michael H. Michaud
  • Wisconsin: Governor Scott Walker (who has adopted a partial Medicaid expansion) defeated Democratic challenger Mary Burke
  • Georgia: Governor Nathan Deal defeated Democratic challenger Jason Carter



November 3, 2014

Week Ahead: Election Impact Conference; Medicaid Conference, Ebola Response & the Health Impact of Climate Change

The mid-term elections on Tuesday are the primary focus ahead of lawmakers’ return next week for a lame duck session. On Thursday, CQ Roll Call is holding a post-election impact conference. Scheduled speakers include notable political insiders and CQ Roll Call reporters and editors.

For those interested in a respite from post-election analysis, the National Association of Medicaid Directors this week hosts a conference on the Medicaid program. The conference begins on Tuesday with an address from Health and Human Services Secretary Sylvia Mathews Burwell. However, the election also impacts the Medicaid program. CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reported (subscription) last week that the election results for state governors’ races could stall or expedite plans for a further Medicaid expansion into states that have not taken advantage of federal funding enticements to expand eligibility for Medicaid program.

The American Association for the Advancement of Science on Tuesday holds a discussion on the work of individuals and governments in West Africa in containing the Ebola virus outbreak. Also on Tuesday, the Center for Global Development hosts a panel discussion on challenges relating to efforts to fight drug-resistant Tuberculosis. Separately, a Society for International Development panel will discuss efforts to engage women as a means to foster stronger health care systems and improved health outcomes.

Meanwhile, a two-day conference begins today at the National Academy of Sciences examines scientific models on the health risks of climate change.  The sessions will be webcast and follows the release this weekend of a new UN report on the dire-consequences of climate change.


October 23, 2014

State Medicaid Directors Respond to Critique of Varying State Standards

Last month, Healthopolis noted a Department of Health and Human Services Inspector General report that surveyed the wide diversity of state approaches to regulating Medicaid managed care programs.

The Inspector General’s analysis prompted the National Association of Medicaid Directors to craft a response to the report, suggesting that the lack of consistency in state supervision of Medicaid programs is not necessarily a failure but rather illustrates different approaches to managed care programs, which are colored by the unique circumstances of each state in managing very complicated factors influencing the Medicaid program.



Health Programs Factor in Upcoming House Committee Leadership Changes

The focus on upcoming November congressional elections understandably centers on possible election results and which party will control the Senate. However, the election of a new Congress, which convenes in January, also starts the process for reconfiguring the leadership of pivotal House committees. Roll Call’s Emma Dumain and Matt Fuller today examine possible GOP leadership changes in 11 different committees.

Health care program funding authority, particularly for the Medicare program, falls under the jurisdiction of the House Ways and Means Committee. The committee’s current chairman, Michigan Republican Rep. Dave Camp is retiring and Wisconsin Republican Rep. Paul D. Ryan has the inside track — but has some competition — to take over the gavel of the powerful tax committee.

Ryan has led a long-running campaign to overhaul the Medicare program as the chief of the House Budget Committee. His annual budget proposals (view the 2015 budget plan) have suggested ideas on overhauling the Medicare program allowing Medicare beneficiaries to choose between competing private coverage programs with the federal government offering premium support payments. In 2011, a liberal advocacy group attacked an earlier Ryan Medicare proposal with a video featuring a Ryan look-alike actor pushing an elderly woman in a wheelchair off a cliff.  At the helm of the Ways and Means Committee, Ryan would have the opportunity to craft a Medicare overhaul measure instead of offering budgetary suggestions.

If Ryan departs from the budget panel, the heir apparent is the committee’s current Vice Chairman, Rep. Tom Price, a conservative physician from Georgia. Price is a staunch opponent of the 2010 health care overhaul law and has authored his own proposal on overhauling health insurance coverage options. Price’s plan relies on offering tax breaks to give people the means to buy health insurance instead of the current health insurance exchange plan subsidies.

October 9, 2014

CBO: Annual Deficit is Lower But Health Program Spending Is Up

The federal government ended the 2014 fiscal year with an estimated $486 billion annual deficit, which is the lowest deficit level since 2008. The Congressional Budget Office monthly budget report pegs the lower deficit estimate largely on increased receipts from taxpayers.

However, overall federal spending — measured as outlays — increased and Medicaid and health insurance subsidy payments increased by 19 percent over 2013 levels. The CBO identifies the 2014 start of subsidized insurance plans and expanded state Medicaid coverage as a main reason for overall spending increase. Federal outlays on Medicaid and insurance premium subsidies increased in 2014 by $49 billion.

In September, the final month of the fiscal year, defense spending and reduced unemployment benefit outlays were down by $2 billion but spending for Medicaid increased 10 percent and Medicare increased 5 percent.





October 8, 2014

Enforcement Delayed on New Home Health Wage Rules

The Department of Labor will temporarily pause enforcement of new overtime and minimum wage rules for home health care workers. The rules, which are set to begin in January, include the elimination of overtime exemptions and the application of minimum wage requirements for workers who help elderly or frail people with activities such as dressing, eating meals and taking medication. An appeal from state Medicaid officials concerned about the cost of the new wage requirements has prompted a six-month suspension of enforcement of the rules.

The Labor Department will publish a policy update on the delay later this week. The final home health wage rules were published in 2013 and set a start date of Jan. 1, 2015. However, several states expressed concerns about budgetary impact on state Medicaid programs of applying higher wage rates to home health workers. The actual start date of the wage requirements will continue to be Jan. 1 but the department will not bring any enforcement action against employers for violating the wage rules through June 30, 2015.

Senate Democrats, acknowledging the concerns of Medicaid officials, applauded the decision. Republicans urged the administration to completely scrap the entire home health worker wage adjustment.





September 30, 2014

State Supervision Varies for Medicaid Managed Care

Many states provide Medicaid managed care plans and the states give the plans wide leeway when it comes to supervising standards for access to health care services. The bulk of persons enrolled in state Medicaid programs are covered by some kind of managed care program. The Department of Health and Human Services Inspector General, in a report on Monday, surveyed the diversity of state approaches to regulating managed care programs.

States allow different types of managed care options, which typically limit patients to a network of medical providers, but the states also provide varying levels of supervision. The inspector general found different standards for access to care and differing levels of effort in identifying violations. Federal supervision of the state Medicaid managed care plans is limited and the National Association of Medicaid Directors last week offered some suggestions to federal officials on improved federal and state supervision of the plans.


September 25, 2014

HHS Reports a Decline in Uncompensated Hospital Care

An objective of the health care overhaul’s provisions allowing states to expand coverage offered through the Medicaid program is the reduction in the burden on hospitals treating uninsured patients and the resulting hospital write-offs for uncompensated care. Hospitals are now beginning to recoup some the cost of treatment of previously uninsured patients through Medicaid, especially in states that have expanded the qualifications for Medicaid coverage.

The Department of Health and Human Services on Wednesday detailed the savings impact on hospitals, noting $4.2 billion in savings in states that have expanded the Medicaid program and $1.5 billion in states that have avoided an expansion. The federal government will pick up all of the expanded Medicaid program costs through 2016 and phase down to 90 percent of costs in 2020.

CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reported that the authors of the law expected a decline in charity care and bad debt as consumers gained insurance coverage. That was also one of reasons why Congress included in the health law billions of dollars in cuts in Medicare and Medicaid payments for hospitals that care for a large share of low-income patients. Additionally, the Affordable Care Act added requirements on charitable hospitals to document and justify policies and limit charges for uncompensated care.






September 23, 2014

Pressure Mounts for Medicaid and Medicare Physician Payment Fixes

Doctors have long-held a prominent lobbying role in Congress. Most of the focus of recent efforts by physician groups revolves around pressing to continue temporary adjustments to several Medicare and Medicaid payment formulas.

In November, members of a  physician group are planning visits to lawmakers on Capitol Hill to urge an extension — beyond the scheduled year-end expiration — of a temporary Medicaid payment boost for primary care doctors. The payment increase was an attempt to reduce the gap between Medicaid and Medicare payment levels. The administration, earlier this month in its stopgap spending bill request, urged lawmakers to extend the primary care payments. But the adopted continuing resolution ignored the White House suggestion. CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reports on plans for the physician visits organized by the American Congress of Obstetricians and Gynecologists.

Also looming on the congressional agenda is the renewal of extended relief from planned cuts slated for next year to the broader Medicare physician payment formula. Congress has acted to thwart a scheduled physician payment cut each year for more than a decade. CQ Roll Call’s Melissa Attias reports that some lawmakers hope to permanently fix the payment formula during this year’s lame duck session. However, a permanent fix has long been a bipartisan objective but has been thwarted by disagreement on how to pay for the payment formula adjustment.

September 22, 2014

Health Insurance Auto-Renewal Process Omits Medicaid Plans

Over the next several weeks, 95 percent of people who signed up last year for a health plan through the federal insurance website,, will be notified that their insurance will automatically renew for 2015. Earlier this year, the Department of Health and Human Service announced the process for the auto-renewal of policies.

However, people who signed up for a Medicaid plan may not know that they must take action to renew their coverage. CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reports that Medicaid recipients must reapply for coverage, even if their personal circumstances have not changed. The Medicaid program, which is largely administered by the states, requires each state to explain the renewal process. The varying state processes and accompanied documentation could result in some people losing coverage.


August 12, 2014

Anti-Fraud Bill Presses CMS to Nix Social Security Numbers on Medicare Cards

Medicare identification cards would no longer display beneficiaries’ Social Security numbers under a new bill outlined recently by the chairman of the House Ways and Means Subcommittee on Health. Rep. Kevin Brady, R-Texas, released the draft text of a measure that compiles a wide range of suggestions to thwart Medicare and Medicaid payment fraud and abuse. The proposals– collected from a bipartisan suggestions offered by committee members — range from halting payments for health services provided to deceased beneficiaries to enhanced fraud abuse monitoring of various specific provider payments, such as those for medical equipment, vacuum erection systems and ambulance services.

The aim of ending the printing of Social Security numbers on Medicare cards is to protect against possible fraud against Medicare beneficiaries, rather than to save the program’s money. The Medicare card is one of the few remaining federal documents that still display the full Social Security number, opening up the possibility for identity theft if the card is lost or stolen.

Eliminating Social Security numbers on the card is a long-running bipartisan congressional objective that has not been taken up by the Centers for Medicare and Medicaid Services. HealthBeat’s John Reichard reported in April on questions about the ID card posed to CMS official at a panel hearing on Medicare fraud. The Medicare agency insists that it lacks the resources to make the change.

The Government Accountability Office in 2012 reviewed several options offered to CMS to change the Medicare card. The suggestions included replacing the number, only partially displaying it, or denoting it in a machine readable bar code.


July 31, 2014

Taxes on Health Care Providers Are Bigger Chunk of Medicaid Funding

A Government Accountability Office report released on Tuesday examines states’ increasing reliance on taxes on health care providers to help cover Medicaid spending.

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